2017: Same old story in healthcare

The health sector in 2017 was characterised by undue delays and hiccups in terms of policy formulation and implementations, resulting in only motion without concrete achievements, reports APPOLONIA ADEYEMI

As Nigerians prepare to bid farewell to 2017, key stakeholders in the health sector are concerned over the non-implantation of the National Health Act (NHA), which was passed into law in 2014. Seen largely as an instrument that could boost health care funding while easing the current burdensome out-of-pocket pocket payment by patients, how to make it operational has been a major concern in 2017.

Monkeypox
Although, the emergence and re-emergence of infectious diseases in the country had begun in 2016, the outbreak of Monkeypox remains the most dreadful, in terms of the impact of the disease of the pox family in the psyche of human beings .

Till date Nigeria aligns with the global community in finding lasting solution to the health challenge posed by Monkeypox. It’s known that death rate from the condition is near zero; the emergence of the medical condition is a sore point for the country’s disease surveillance system. This trend emerged in spite of expert projections in the past two years that infectious diseases of old could re-emerge.
Monkeypox is an infectious disease caused by the monkeypox virus. Symptoms begin with fever, headache, muscle pains, swollen lymph nodes, and feeling tired. This is then followed by a rash that forms blisters and crusts over.

Monkeypox is not the only disease that plagued Nigerians this year, many citizens similarly came down with Lassa fever, the most dreadful medical condition in the country presently on account of the high death rate arising from it. This is the disease that even medical doctors and other health workers dread most because of its highly contagious nature. Several health workers in the course of duty have been infected and died.

However, the Federal Ministry of Health (FMOH), the Nigerian Centre for Disease Control (NCDC) in partnership with international partners have increased surveillance to track both the old and new emerging diseases.
The FMOH and NCDC have however been providing free treatment for Nigerians that came down with these diseases including dengue fever, the outbreak of which did not reach epidemic level throughout the year. These are not the only diseases that troubled Nigerians in 2017.

Malaria
Malaria fight is another area where Nigeria recorded poor performance. The latest World Malaria Report 2017, issued by the World Health Organisation (WHO) in November, shows that after an unprecedented global success in malaria control, progress has stalled.

Going by details of the report, there were an estimated five million more malaria cases in 2016 than in 2015 and malaria deaths stood at around 445 000, a similar number to the previous year.
The Director-General of the World Health Organisation (WHO), Dr. Tedros Adhanom Ghebreyesus said, “In recent years, we have made major gains in the fight against malaria. We are now at a turning point. Without urgent action, we risk going backwards, and missing the global malaria targets for 2020 and beyond.”

Based on WHO’s Global Technical Strategy for Malaria which had called for reductions of at least 40 per cent in malaria case incidence and mortality rates by the year 2020, the WHO’s latest malaria report is an indication that the world community is not on track to reach these critical milestones.

However, at the centre of the problem is insufficient funding at both domestic and international levels, resulting in major gaps in coverage of insecticide-treated nets, medicines, and other life-saving tools.
An estimated US$ 2.7 billion was invested in malaria control and elimination efforts globally in 2016. That is well below the US $6.5 billion annual investment required by 2020 to meet the 2030 targets of the WHO global malaria strategy.

In 2016, governments of endemic countries including Nigeria provided US$ 800 million, representing 31 per cent of total funding. The United States of America was the largest international funder of malaria control programmes in 2016, providing US$1 billion (38 per cent of all malaria funding), followed by other major donors, including the United Kingdom (UK) of Great Britain and Northern Ireland, France, Germany and Japan.
The report shows that, in 2016, there were an estimated 216 million cases of malaria in 91 countries, up from 211 million cases in 2015. The estimated global tally of malaria deaths reached 445 000 in 2016 compared to 446 000 the previous year.

The WHO estimates that the African Region continues to bear an estimated 90 per cent of all malaria cases and deaths worldwide. Fifteen countries – all but one in sub-Saharan Africa – carry 80 per cent of the global malaria burden.

“Clearly, if we are to get the global malaria response back on track, supporting the most heavily affected countries in the African Region including Nigeria must be the primary focus,” said Dr. Tedros.
According to the report, the African Region has seen a major increase in diagnostic testing in the public health sector: from 36 per cent of suspected cases in 2010 to 87 per cent in 2016. A majority of patients (70 per cent) who sought treatment for malaria in the public health sector received artemisinin-based combination therapies (ACTs) – the most effective antimalarial medicines.

However, in many areas, access to the public health system remains low. National-level surveys in the African region show that only about one third (34 per cent) of children with a fever are taken to a medical provider in the public health sector.

National Health Insurance Scheme (NHIS)
Similarly, another key aspect that could have facilitated wider access to care is the expansion of the National Health Insurance Scheme (NHIS). From the inception of the scheme 12 years ago, only about five per cent of the nation’s population was captured as enrollees, which has presently reduced to about three per cent following the exit of some that have outgrown the scheme. Instead of expanding the scheme to include more Nigerians, 2017 witnessed allegations of large scale fraud involving key operators of the NHIS all of which openly traded blames of fund misappropriation.

Among those named for alleged misappropriation are Prof. Usman Yusuf., the now suspended executive secretary of the NHIS, members of the Health and Managed Care Association of Nigeria (HMCAN), an umbrella body of Health Management Organisations (HMOs), lincensed operators of the NHIS. Yusuf, was appointed by President Muhammadu Buhari as the Executive Director of the NHIS.

In the heat of the allegations which drew numerous petitions against Yusuf, he was alleged to have misappropriated N292 million which he allegedly spent on health care training “without recourse to any appropriate approving authority.

The Mister of Health, Prof. Isaac Adewole subsequently suspended him in July, to pave way for fair and uninterrupted investigation of the panel constituted to probe him. After the committee found Mr. Yusuf “culpable in many areas” of his performance, the minister of health extended his suspension indefinitely pending the decision of President Buhari on the matter.
Subsequently, the Federal Government appointed Mallam Attahiru Ibrahim as acting executive secretary of the NHIS.

Counterfeit drugs
In the year under review, the menace of fake drug continued unabated. During their 90th 2017 Annual National Conference, the Pharmaceutical Society of Nigeria (PSN) which held in Umuahia, Abia State from November 6 to 11, the Chief Economist of PricewaterhouseCoopers (PwC), Andrew S. Nevin, in a keynote address, said that counterfeit medicines account for 17 per cent of the generic drugs in supply, noting that various sources have made varying claims at different times on this figures. What the true figures are is a very contentious issue.

While calling for the drug regulatory environment in the country to be strengthened, a National Chairman of the Association of Community Pharmacists of Nigeria (ACPN), Dr. Albert Kelong Alkali said all open drug markets should be closed down, while calling on Federal Government to support the Pharmacist Council of Nigeria (PCN), the National Agency for Food and Drug Administration and Control (NAFDAC) in this regard. According to him, a lot of Nigerians were either dying or being maimed as a result of ingesting fake medicines.

To this end, he called on the Federal Government to declare emergency on the issue of fake drugs, adding that the Federal Task Force on Fake and Counterfeit Drugs should be inaugurated and reinforced.
Although, a June 2017 timeline had been fixed to dismantle all open drug markets located in Onitsha, Aba, Sabongeri in Kano State, among others, the Federal Government and key partners did not meet that deadline due to lack of political will Alkali asserted.

Traditional Medicine
In spite of a United Nations (UN) declaration more than 10 years ago to adopt traditional Medicine as part of acceptable medications because their accessibility, affordability and local acceptance, several factors continue to hinder wider use of traditional medicine products. Key practitioners still lament the hindrance in including traditional medicine into mainstream health system as an alternative medicine, of choice for consumers of health. That lack of inclusion and practioners’ delay in modernising their production in terms of providing scientific backing for their claims and hinderance in adopting modern and up-to-date packaging, still limit the wider acceptance of the products throughout the year in review.

In 2017 the traditional medicine practitioners under the auspices of the National Association Of Nigerian Traditional Medicine Practitioners (NANTMP) partnered the Nigerian Institute of Medical Research (NIMR) which is doing clinical trials of their medications to standardise the products’ claims. Similarly, the Pax Herbal Laboratories similarly signed an MoU with NIMR this year in this regard. More practitioners are expected to key into this development with a view to enhance their practice.

In his assessment of how the health sector faired in 2017, President of the Nigeria Medical Association (NMA), Prof. Mike Ogirima said the country’s health indices were far from getting better. “We have had issues with government not implementing certain programmes that would have improved the indices of the health of Nigerians, particularly the NHA.

Highlighting those to benefit more from the rapid implementation of NHA and the of Universal Health Coverage (UHC), he said: “We thought the 2018 budget will capture certain privileges for the vulnerable population: The pregnant women, children under five and road accident victims.

“One per cent of the consolidated revenue should have been set aside from the NHA as basic health trust fund for such group of people.”
This is the third year since the NHA was enacted; so, we need constant advocacy not only from health practitioners but also from the people in the media to remind government to do the needful because, even if you have three per cent of our population captured under the NHIS as it is today, “Without extra funding, we cannot get it right. We can now talk of Universal Health Coverage (UHC), which means every Nigerian should be able to access health, no matter how little, from the comfort of his room and get better.”

Poor health Budget
Furthermore, the President of the NMA lamented continued poor budget allocated to health. Irrespective of African government’s Abuja Declaration in 2001 to budget 15 per cent of annual budgets to health, Ogirima lamented that Nigeria has continued to earmark between three to four per cent of its annual budget to health.

Brain Drain
The brain drain of medical doctors and other health care practitioners including nurses, pharmacists, among others rose to unprecedented levels in the year under review.
The NMA similarly urged governments at all levels to intervene to stem the tide. Ogirima noted that in two years – 2016 and 2017, over 600 Nigerian trained doctors dumped the country to take better paid employment abroad. All government must therefore prioritise the welfare of doctors and other health care workers to curb this unwarranted exodus, Ogirima said.

Marginalisation
On his part, President of the Joint Health Sector Unions (JOHESU), Biobelemoye Josiah said: “there is a bleak future in the area of industrial harmony due to Federal Government’s insensitivity and lack of will to address the demands of JOHESU, a cluster of health care workers constituting 95 per cent of professionals in the health system.

He noted that health workers operating under JOHESU have been seriously marginalised in the health sector without any sign of ending the ordeal of affected persons.
“Considering the bias of the Federal Government against our members since 2015, our patience has gotten to breaking level. “This year, there were some efforts to sit down and talk, but as I speak with you some of the cardinal issues arising since 2014, such as the adjustment of the Consolidated Medical Health Salary Scale (CONHESS), has not been resolved.

“We would have been on strike this festive season but we rejected that option because we have to keep the Holy period holy; hence we have restrained ourselves from resuming our strike action.”
However, Josiah noted that while the Federal Government has not implemented the key aspect of the agreement on adjusting CONHESS before the next minimum wage comes out, there were approvals for the demands from the National Association of Resident Doctors (NARD) on December 21 for which a circular was issued because of NARD’s strike action.

However whenever such demand involves JOHESU members, Josiah lamented that the Federal Government would say the economy was bad; there was recession; and that it takes time for President Buhari to approve the demand.
On the contrary, similar demand from NARD since 2014 has been approved. While a related demand from JOHESU was pending, the Federal Government has again approved another related demand for medical House Officers. “So, you can see the bias in the Health sector,” he lamented.

Lopsided appointments
Tracing the background of the marginalistion of health workers, Josiah blamed the development on political appointments which gives the positions of minister of Health, the Minister of State for Health and that of the Minister of Labour and Employment solely to medical doctors, a development that shuts out JOHESU members from being represented at the top managerial level of the health sector.

“Where the less than five per cent of health sector staff alone occupies all the decision-making level, he noted: “certainly JOHESU cannot get a fair deal from the system,” adding that sustaining this situation cannot promote peace in the health sector.”
President of JOHESU therefore called for fair treatment for all including professionals and the non-professionals.

Based on the deliberate delays in meeting the demands of JOHESU, which predates the administration of the current JOHESU executives, Josiah said the Federal Government was forcing health workers under JOHESU to make the forth-coming year a strike-infested 2018, adding, “We shall not shy away from that. Nigerians will understand our plight. If they push us that far, we will give it back to them because we are not slaves in the health sector.”

Side effects, barrier to family planning

Available data shows that one in four pregnancies in the country is unplanned for. Experts say using family planning would prevent them as well as save lives. APPOLONIA ADEYEMI reports

Mrs. Teniola Fadairo, 54 years, a mother of four had set out to embrace family planning (FP). As soon as she got married in 1985, at the age of 24 years, she conceived without delay, prompting the delivery of her first baby two years after, prescisely in 1987. “It was the preference of spacing the arrival of the next baby that made my husband and I to embrace FP after the birth of our first baby, Mrs Fadairo told the New Telegraph during a field trip to the Lagos Island Maternity last week.”

After counseling by health workers, she adopted the intrauterine contraceptive device (IUCD) which was inserted in her uterus through the vagina, she disclosed.

An IUCD is a small, “T-shaped” contraceptive device which is placed in a woman’s uterus (womb). It is also known as the IUD, loop or copper coil.

IUCDs are made of flexible plastic with a coating of thin copper wire. It has one or two soft threads on the end. These thin threads hang through the opening at the entrance of the womb (cervix) into the top of the vagina.

An IUCD works by stopping sperm reaching an egg. It does this by preventing sperm from surviving in the cervix, uterus or fallopian tube. It may also work by stopping a fertilised egg in the woman from implanting in the uterus.

Relating her experience about the IUCD, Fadairo said: “I was not feeling fine when I was using the IUCD; I was not comfortable with it at all. I did not feel pain or discomfort, but I was experiencing some discharge from my vagina.

“After some months, I went back to the health facility and informed them about this. Although, they assured me that it would be over soon and that I would feel normal again, but I insisted that it should be removed.”

When the medical doctor on duty at the private facility where I sought the service, checked me and asked if I wanted to continue with the IUCD, I said, “No,” and it was promptly removed.

Fadairo who abandoned the use of FP due to the highlighted discomfort, later had three more children, using natural method only throughout the period of her reproductive years. “I thank God today that things went well. It was not by my power,” she told the New Telegraph.

For another housewife, Mrs Tayo Olubi, also a Lagos resident it was a different scenario. She got pregnant four months after the delivery of her first child. Olubi who did not breastfeed her son exclusively found that she had become pregnant four months after delivery.

She was not only confused, but had challenges coping with nursing the first child and going through another pregnancy at a time that it was too close to the previous one.

Convinced that she could not cope with this challenge, she visited a traditional medicine practitioner who prescribed a local herb with which the pregnancy was terminated. Within days of administering the herb, the five months pregnancy was terminated leading to days of profuse bleeding. Although, she was rushed on emergency to a nearby public health facility, Mrs Olubi died before getting help in the hospital.

The World Health Organisation (WHO) defines family planning as a voluntary measure that “allows individuals and couples to anticipate and attain their desired number of children and the spacing and timing of their births. It is achieved through use of contraceptive methods.”

FP enables couples and individuals to exercise their rights to determine whether to have children, when and how often to have children, and when to stop; and provides information and services to act on the right. This is vital to safe motherhood, healthy families and prosperous communities.

Contraceptive use remains very low in Nigeria. The Guttmacher Institute (GI) estimates that in 2013, only 16 per cent of all women of reproductive age in Nigeria,15 to 49, were using any contraceptive method, and only 11 per cent were using a modern method—levels that remain virtually unchanged since 2008.”

Besides, available data from GI shows that in 2012, about one-fourth of Nigeria’s 9.2 million pregnancies were unintended —a rate of 59 unintended pregnancies per 1,000 women aged 15 to 49.

According to the data, more than half (56 per cent) of these unintended pregnancies ended in an induced abortion; 32 per cent ended in an unplanned birth and 12 per cent in a miscarriage.

Based on the highlighted statistics, it is very clear that abortion arising from unintended pregnancies remain high in spite of the restrictive abortion laws in the country. In Nigeria, abortion is legal only when performed to save a woman’s life. Still, abortions are common, and most are unsafe because they are done clandestinely, by unskilled providers or both.

However, these unnecessary abortions could easily be averted if Nigerians of reproductive age use FP services which experts said could help prevent unintended pregnancies as well as space births for mothers, a measure that would boost their health.

One of the major problems hindering the implementation of FP is the barriers that are making women not to uptake services, said Dr. Ejike Oji, chairman of the Advancement of Family Planning (AAFP).

Oji who is also the chairman, Coalition for Maternal, Child and New Born and Adolescent Health Accountability in Nigeria (C4MAN), said, “The most important barriers we have seen are misconceptions. People feel that when they uptake FP services they won’t be able to have babies again or that something bad will happen to them.”

On the contrary, Oji described such claims, most of which were based on traditional and religious believes as misconceptions and myths.

On the issue of negative reaction to FP use in some women such as the one experienced by Mrs Fadairo who ultimately dumped FP, Oji said FP was such medical services that were personal. “What is good for you might not be good for the next person and that is why we are saying that practitioners must be properly trained to provide the services.

“You shouldn’t just go somewhere to access FP. You must be properly counseled. There are so many methods. It is during the counseling that practitioners will identify the one that is good for each person and give that one that is specifically for you and you won’t have any problem.”

When side effects were experienced, Oji advised clients to report to the facilities. Often, side effects could be temporary and often fizzle out, with normal situation returning. Sometimes, it may be necessary to change FP methods in individuals to address side effects, he added.

On the prevention of unintended pregnancies, he lamented that Nigeria’s maternal mortality rate is 576 deaths per 100,000 live births.

Every day about 111 women and girls in Nigeria die due to preventable pregnancy and child birth related complications (every hour five women die), according to data from the Nigerian Demographic and Health Survey (NDHS). Nigeria accounts for one in nine maternal deaths world wide

Thirty-four per cent of such deaths can be prevented by increasing access to and uptake of FP, he asserted.

Oji described FP as key in terms of child survival and women’s health. “What we are saying is that women should be able to space their children appropriately, limit the number of children they want and also not start their reproductive health production too early.”

Medical experts said pregnancies that are too early, too close, too late or too many carry extra hazards not only for the health of the woman but also for the child.

Previous research shows that the greater number of women that died during child birth in Nigeria is below 18 years. In fact they have the second highest number of deaths, estimated at 70 per cent, from pregnancy and pregnancy related cases.

A recent study by the United States (U.S.) Centers for Disease Control and Prevention’s National Center for Health Statistics also shows that using FP is beneficial and could stem unintended pregnancies.

According to findings of the study released on June 22, 2017, although, more than half of American teens had sex by age 18, teenage pregnancy and birth rates extended their two to 1/2-decade decline because of increased contraceptive use.

Most of the 55 per cent of teenagers who had sex by 18 used some type of protection, typically a condom, the study of more than 4,000 teenagers showed.

Some 80 per cent of teenagers employed a contraceptive method during their first sexual encounters, according to the study.

Consequently, medical experts are of the view that up taking FP services was in the overall interest of mothers and babies. It would not only benefit clients like Mrs. Fadairo, using FP could prevent unnecessary death in abortions such as the one that killed Mrs. Olubi.

Codeine: Lagos targets Mental Health Law, parenting

In order to effectively tackle drug abuse including that of codeine in the country, the Commissioner for Health in Lagos State, Dr. Jide Idris said the Mental Health Law that would address the menace in Lagos would soon be passed into law.

The law, which has gone through the Second Reading was however still in the process of becoming a legal document, said Segun Olulade, chairman of the House Committee in Lagos State House of Assembly,

However, while the state is still awaiting the passage of the Bill, Idris has urged parents and guardians to establish close relationship with their children and wards to enable them monitor the children with a view to notice change in their behaviour and attitude.

According to Idris, it has become necessary for parents and guardians to uphold uprightness in their children through the reward of good behaviour. He said if parents rewarded good behaviour and achievements among the youths, they would be of good behaviour.

Highlighting other things the Lagos State Government would do to address drug abuse, Idris said although, Lagos State Interministerial Committee on Drug Abuse was established in 1993, the body would be used to sensitise the public on the menace of drug abuse and illicit trafficking.

Already, he noted that the Committee has engaged in campaign in form of awareness programmes, rallies and lectures.

The commissioner for health said the established Rehabilitation Centres in the state would take care of people affected by drug abuse. “The Lagos State Task Force on fake and counterfeit drugs will monitor sales and distribution of pharmaceutical products in the state” while the Task Force would sanitise the drug distribution channels by sealing the unregistered premises in the state.

Codeine is a short-acting narcotic analgesic prescribed by physicians most often used for the treatment of pain relief. Codeine can be highly addictive and provides the user with an overall sense of calm and feelings of pleasure. When codeine is used it enters the brain and causes the release of neurotransmitters that stimulate the reward center of the brain, leaving the user feeling intense feelings of well-being and pleasure. This kind of pleasure can lead to both psychological and physical dependence.

Some individuals use codeine for legitimate medical purposes, but over time develop an addiction problem. After prolonged use, an individual develops a tolerance for this substance and needs to take more and more of the drug in order to feel the effects. Someone who is addicted to codeine can begin to feel symptoms of withdrawal if they go even for a short time without using the drug.

On the role of the Lagos State Government, he said, apart from relying on the provisions of the Mental Health Law that would pave the way for the achievement of sustainable mental health for people in the state, the government would seal all unregistered premises with a view to limiting access to unwholesome and drugs of abuse.

Since 2015, Codeine has nearly overtaken Tramadol as the most abused opiate in Nigeria, said Idris, adding that thousands of young people in Nigeria have become addicted to codeine cough Syrup – a medicine that has become a street drug.

Nigeria government reports indicate that three million bottles are drunk every day in Northern part of the Country alone.

An investigative documentary, ‘Africa Eye’ launched recently by the BBC, the result of a five – month in – depth undercover investigation into the plague of addiction to cough mixtures across Nigeria, exposed major ills in the Nigeria Pharmaceutical Industry.

The documentary revealed how major Nigeria Pharmaceutical Industries were moving their legally produced products via back doors of their factories and into the hands of drug dealers who sell the dangerously addictive sweet tasting opioid for the price of a bottle of cola.

Other individuals become addicted to codeine and begin to use it to manage other problems in their lives, such as emotional pain or stresses due to the euphoric feelings it causes.

According to Idris, someone who becomes physically dependent upon codeine cannot stop the drug without supervision of a trained medical professional because of the following effects he/she will experience if stopped suddenly:

The psychological symptoms are hallucinations, delusions, memory loss and lack of emotions.

Someone who becomes physically dependent upon codeine cannot stop the drug without supervision of a trained medical professional because of the following effects he/she will experience if stopped suddenly craving for the drug, runny nose, intense sweating, chills, goosebumps, stomach cramps, psychosis, suicidal thoughts and hallucination.

Rehabilitation: Cases of codeine addiction should be referred to State Health Facilities for expert management.

Brai: Calorie-rich diet driving chronic diseases

Dr. Bartolomew Brai is the President of Nutrition Society of Nigeria (NSN). In this interview, he discusses the impact of inadequate nutrition: Low intelligence, stunting and wasting in children and factors that would reverse the trend in this interview with APPOLONIA ADEYEMI

What are the factors hindering this country from achieving adequate nutrition for the populace?

Number one is the enabled environment. The government may be talking about it but they are not committed to nutrition as such.

Now you see that international organisations like UNICEF have to come in to provide support.

Similarly, the World Health Organisation (WHO) and the rest of them are the ones that are giving funds and because the funds are made available that we have some level of activities.

This present administration made agenda for one meal per day for the school children.

A child who is hungry won’t be attentive in class even if he is awake, he will just be looking as if he is not part of that class because his attention is poor and he cannot concentrate on what is going on in that class, but with a meal a day, you see the children in class are alert, active and learn better.

In some cases, it not that they are poor but the children may not want to go to school; but when the school-meal programme is available, it’s an incentive. Based on the meal, they go to school because of the food and some parents also send their children to school because they know there is a meal waiting for them to eat in a day.

School-meal programme encourages school enrolment and school dropout will reduce and then it will help the learning of these children. It will help school children to learn better and perform better in school and of course lf you educate your populace you are investing in them and it will have impact on the economy in the future.

What is the economic implication of inadequate nutrition?

If a child is suffering from iodine deficiency, his learning capacity will be low and he cannot learn well. Such a child will grow up to be a problem. Number one problem he will have is poor education and because of this deficiency his work capacity will be reduced. So, we have both learning and work capacity affected and if work capacity is reduced, there is low productivity. That is economic angle and this will have impact on the people.

What can be done to improve the nutritional the populace and what should be the role of governments?

Well, we have a role to play in awareness creation. Some people have the food but do not know what to eat. The rich people you see visiting fast food outlets; that is where they eat.

Many of us have abandoned our local food. We have shifted to western diets and they are high in calories and fats and these are the diets that expose people to chronic diseases.

We talked about double burden of malnutrition now we have triple burden. We have under nutrition- not eating well, over nutrition-eating too much and the micro-nutrient deficiency, which we do not notice easily because it is in receding order but it is there. Also, we have abandoned our foods and vegetables and we do not take supplements in Nigeria. Besides, many cannot afford supplements.

Are these supplements in form of tablets or natural supplements?

Let’s not go there. The best approach is to eat your natural fruits and vegetables. I recommend that you eat fruits five times in a day. If you cannot, try to have them at least once or twice daily.

A large number of children in the country are being wasted, occasioned by poor nutrition. How did Nigeria get there?

Well, when it comes to under nourishment, when we look at the issue we can say that it could be as a result of poverty or lack of education. Even when there is food and people do not take enough, it could result to inadequate nutrition. In addition, wrong choices of food could also result to poor nutrition.

On hygiene, you can’t separate hygiene from nutrition because even when you have food and they are not hygienic enough it will still lead to disease conditions and when you have disease, the amount of food the body will assimilate will be very poor and will still lead to malnutrition. It is something that has been there in the system and it is not peculiar to our nation.

The only thing is that the attention we have paid to it is not the best over the years. If we can tackle it, it will help. For instance, we could focus on the girl child when they are in their adolescent stages, giving them the proper education so as to prepare them for motherhood.

Consequently, before and during pregnancy we take good care of their nutrition and health and that way we will have healthy children. The problem is that after the 1,000 days, once a child is not properly fed and after two years when the child is growing and becomes stunted, there is no remedy. A stunted mother is most likely to give birth to a stunted child so the cycle continues; hence, it becomes a generational problem.

What are the local food sources of iron and iodine?
The easiest source is the iodine salt. There is a policy in Nigeria that salt should be fortified with iodine. So, what we need to do is encourage people to take enough of iodine.

For iron, the easiest source is vitamin A, which can be gotten from liver, meat and beta carotene from fruits like orange and mango. Also, iron can be got from red meat, which some people run away from. However moderation is the key. Beans are also good sources.

The government will help by endorsing the fortification of some of our foods, which are endorsed by the Nutrition Society of Nigeria (NSN).